The Hospital to Home Study: A Pragmatic Trial to Optimize Transitions and Address Disparities in Asthma Care

从医院到家庭研究：优化过渡和解决哮喘护理差异的务实试验

• 批准号: 10583611
• 负责人: Kavita Parikh
• 金额: $ 90.7万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583611
• 关键词: Academic achievement; Acute; Address; Admission activity; Adolescent; Adult; Affect; American; Asthma; COVID-19 pandemic effects; Caregivers; Caring; Child; Child Care; Child health equity; Childhood; Childhood Asthma; Chronic Disease; Clinical; Cognition; Community Hospitals; Dedications; Disease; Disparity; Emergency department visit; Face; Feedback; Goals; Guidelines; Hand; Health; Home; Hospitalization; Hospitalized Child; Hospitals; Individual; Infrastructure; Inpatients; Intervention; Interview; Methods; Mission; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Outcome; Participant; Pediatric Hospitals; Pediatric Research; Pharmaceutical Preparations; Prevention; Preventive Health Services; Public Health; Quality of Care; Reduce health disparities; Research; Resources; School Drop-Outs; School-Age Population; Schools; Site; Student Dropouts; Testing; United States National Institutes of Health; Update; Variant; Work; Youth; acceptability and feasibility; aged; asthma exacerbation; child services; clinical practice; community engagement; comparison intervention; disorder control; disparity reduction; effectiveness/implementation trial; evidence base; follow-up; group intervention; health care disparity; health care service utilization; health disparity; health equity promotion; health outcome disparity; high risk; high risk population; hospital readmission; implementation evaluation; implementation facilitators; implementation intervention; improved; improved outcome; innovation; insight; interdisciplinary approach; mortality; multi-component intervention; novel; patient oriented; pilot trial; pragmatic trial; premature; primary care provider; programs; provider communication; racial disparity; randomized trial; recruit; socioeconomics; standardize guidelines; successful intervention; telehealth; trial design; trial enrollment; usual care arm

Despite evidence-based NIH guidelines for asthma, overall morbidity among children has not significantly decreased. In the US, asthma accounts for >150,000 hospitalizations, >600,000 emergency department visits, and nearly 14 million missed school days annually. Striking socioeconomic and racial inequities persist with under-resourced children incurring a disproportionate share of asthma morbidity. Our long-term goal is to improve health outcomes and reduce disparities in asthma morbidity for all children. Our team will address critical barriers to achieving broad-scale improvements in outcomes for all children hospitalized with asthma in the US, in any setting. This proposal’s overall objective is to improve asthma outcomes by conducting a patient-centered, multicomponent intervention focusing on under-resourced children with asthma at both children’s (ChH) and community hospitals (CH). Intervention components are navigation support, medications in-hand at discharge, primary care provider communication, school-based therapy, and home assessment. Leveraging feedback from stakeholders and building on the telehealth infrastructure, we will utilize a pragmatic effectiveness-implementation trial design to test the overall hypothesis that a refined version of the Hospital-to- Home (H2H) intervention will reduce asthma readmissions over a 12-month follow-up period. The hypothesis will be tested in the following aims. (1): Engage key stakeholders to identify barriers and facilitators for implementation of the components of H2H at children’s (ChH) and community hospitals (CHs). We will conduct qualitative interviews to identify barriers and facilitators and refine each component for optimal implementation. (2): Evaluate health outcomes of the H2H intervention compared to usual care control group for children hospitalized with an asthma exacerbation at ChH and CH sites. We propose a multi-center, randomized trial enrolling 340 caregiver-child (aged 4-12yrs) dyads during hospitalization to a multi-component intervention. (3): Evaluate implementation of each component of the H2H intervention and assess impact of implementation on health outcomes. We will evaluate feasibility, acceptability, and fidelity using mixed-methods to assess variation in implementation of each component across sites and their impact on health outcomes. By focusing on broader implementation at both ChHs and CHs, this innovative proposal has significant implications for improving asthma management and reducing health disparities incurred by under-resourced school-aged children. This proposal is aligned with NIH’s mission to address health disparities and will provide crucial insights in intervention implementation at all types of hospital settings that care for children. Because the hospitalization for children with asthma serves a high-risk population who may otherwise be difficult to reach, identifying the most clinically effective method by which to deliver a preventative health service is urgently needed. This work has the potential to shift current hospitalization clinical practice paradigms from only acute encounters for asthma exacerbations to the broader management of public health prevention.

尽管NIH的哮喘指南是循证的，但儿童的总体发病率并不显著 减少了。在美国，哮喘导致15万人次住院，60万人次在急诊科就诊。 每年有近1400万人缺课。严重的社会经济和种族不平等现象依然存在 资源不足的儿童在哮喘发病率中所占比例不成比例。我们的长期目标是 改善健康结果，减少所有儿童在哮喘发病率方面的差异。我们的团队将解决 年实现所有哮喘住院儿童预后广泛改善的关键障碍 美国，在任何情况下。这项提案的总体目标是通过开展一项 以患者为中心的多组分干预，重点关注资源不足的哮喘儿童 儿童(CHH)和社区医院(CH)。干预组件包括导航支持、药物 出院时手把手、初级保健提供者沟通、校本治疗和家庭评估。 利用利益相关者的反馈并在远程医疗基础设施的基础上构建，我们将利用务实的 有效性-实施试验设计以测试总体假设，即改进版本的医院到- 家庭(过氧化氢)干预将在12个月的随访期内减少哮喘的再入院。假说 将在以下目标中进行测试。(1)：让关键利益攸关方参与确定障碍和促进者 在儿童(CHH)和社区医院(CHS)实施过氧化氢成分。我们将进行 进行定性访谈，以确定障碍和促进者，并改进每个组成部分，以实现最佳实施。 (2)评价儿童过氧化氢干预与常规护理对照组的健康结局 在CHH和CH地点因哮喘加重而住院。我们建议进行一项多中心随机试验。 在住院期间纳入340名照顾者-儿童(4-12岁)的双胞胎参加多组分干预。(3)： 评估过氧化氢干预措施的每个组成部分的执行情况，并评估执行情况对 健康结果。我们将使用混合方法评估可行性、可接受性和保真度 每个组成部分在不同地点的实施情况及其对健康结果的影响。通过聚焦 关于在CHHS和CHS更广泛地实施，这项创新的建议对以下方面具有重大影响 改善哮喘管理，减少学龄儿童资源不足造成的健康差距 孩子们。这项提案与美国国立卫生研究院解决健康差距的使命相一致，并将提供至关重要的 在所有类型的照顾儿童的医院环境中实施干预措施的见解。因为 哮喘儿童的住院服务于高危人群，否则他们可能很难接触到， 迫切需要确定提供预防性卫生服务的最有效的临床方法 需要的。这项工作有可能改变目前的住院临床实践范式，从仅仅 从哮喘恶化的遭遇到更广泛的公共卫生预防管理。